This chapter establishes certification standards and criteria for Community Residential Mental Health Facilities (RCFs) in Oklahoma, as administered by ODMHSAS. Operators must meet requirements covering staffing, resident rights, activities, health assessments, medication administration, transportation, and continuity of care agreements with community behavioral health providers. Enhanced RCFs serving adults with serious mental illness face additional requirements including minimum staffing ratios, a full-time registered nurse, and physician and dietitian consultation agreements. Compliance is determined through on-site visits, documentation reviews, and staff and resident interviews.
View official sourceThis chapter sets forth the Standards and Criteria used for determining certification of mental health residential care facilities. (43A O.S. § 3-315) The rules regarding factors relating to the certification processes, including, but not necessarily limited to, applications, fees, requirements for, levels of, required scoring levels, and administrative sanctions, are found in OAC 450:1, Subchapter 9. Rules outlining general certification qualifications applicable to facilities and organizations certified under this Chapter are found in OAC 450:1-9-5 through OAC 450:1-9-5.3. The following words or terms when used in this chapter shall have the following meaning, unless the context clearly indicates otherwise: "Abuse" means the causing or permitting of harm or threatened harm to the health, safety, or welfare of a resident by a caretaker responsible for the resident's health, safety, or welfare, including but not limited to: non-accidental physical injury or mental anguish; sexual abuse; sexual exploitation; use of mechanical restraints without proper authority; the intentional use of excessive or unauthorized force aimed at hurting or injuring the resident; or deprivation of food, clothing, shelter, or healthcare by a caretaker responsible for providing these services to a resident. "ADL" means activities of daily living. "Administrator" means the person who is in charge of a community residential mental health facility and who devotes at least one-third (1/3) of his or her full working time to on-the-job supervision of the community residential mental health facility. "Adults who have a serious mental illness" means persons eighteen (18) years of age or older who show evidence of points of (A), (B) and (C) below: (A) The disability must have persisted for six months and be expected to persist for a year or longer. (B) A condition or serious mental illness as defined by the most recently published version of the DSM or the International Classification of Disease (ICD) equivalent with the exception of DSM "V" codes, substance abuse, and developmental disorders which are excluded, unless they co-occur with another diagnosable serious mental illness. (C) The adult must exhibit either (i) or (ii) below: (i) Psychotic symptoms of a serious mental illness (e.g. Schizophrenia characterized by defective or lost contact with reality, often hallucinations or delusions); or (ii) Experience difficulties that substantially interfere with or limit an adult from achieving or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative, or adaptive skills. There is functional impairment in at least two of the following capacities (compared with expected developmental level): (I) Impairment in self-care manifested by a person's consistent inability to take care of personal grooming, hygiene, clothes and meeting of nutritional needs. (II) Impairment in community function manifested by a consistent lack of appropriate behavioral controls, decision-making, judgment and value systems which result in potential involvement or involvement with the criminal justice system. (III) Impairment of social relationships manifested by the consistent inability to develop and maintain satisfactory relationships with peers. (IV) Impairment in family function manifested by a pattern of disruptive behavior exemplified by repeated and/or unprovoked violence, disregard for safety and welfare of self or others (e.g., fire setting, serious and chronic destructiveness, inability to conform to reasonable limitations and expectations. (V) Impairment in functioning at school or work manifested by the inability to pursue educational or career goals. "Clubhouse" means a psychiatric rehabilitation program currently certified as a Clubhouse through the International Center for Clubhouse Development (ICCD). "CMHC" means community mental health center. "Continuity of care agreements" means an agreement between the community residential mental health facility and providers of critical and comprehensive community based behavioral health services, including but not limited to a provider of inpatient behavioral health care and a local provider of community-based behavioral health services. Continuity of care agreements shall specify the responsibility of each entity related to assuring continuous and coordinated care on behalf the residents. "Co-occurring disorder" means any combination of mental health and substance abuse symptoms or diagnosis in a resident. "Corporal punishment" means any physical punishment including, but not limited to punching, slapping, kicking, spanking, or whipping. "Crisis stabilization" means emergency, psychiatric, and substance abuse services for the resolution of crisis situations and may include placement of an individual in a protective environment, basic supportive care, and medical assessment, and, if needed, referral to an ODMHSAS certified facility having nursing and medical support available. "Direct care staff" means any staff member who, in the performance of his or her routine duties has contact with residents and is required to meet the training requirements for community residential mental health staff as listed in the "Standards and Criteria for Community Mental Health Residential Facilities". "Enhanced residential care facility" means a community residential mental health facility meeting all statutory and regulatory requirements of the ODMHSAS and OSDH and which specifically serves only "Adults who have a serious mental illness" who cannot be accommodated in a non-enhanced community residential mental health facility. "General psychiatric rehabilitation program" or "PSR" means a type of psychiatric rehabilitation program which focuses on long term recovery and maximization of self-sufficiency, role function and independence. General psychiatric rehabilitation programs may be organized within a variety of structures which seek to optimize the participants' potential for occupational achievement, goal setting, skill development and increased quality of life. "Health care services" means services provided by health care professionals and includes, but is not limited to dentists, optometrists, and podiatrists. "Independent living skills, assistance in development of" means all activities directed at assisting individuals in the development of skills necessary to live and function within the community. "ODMHSAS" means the Oklahoma Department of Mental Health and Substance Abuse Services. "Oklahoma Administrative Code" or "OAC" means the publication authorized by 75 O.S. § 256 known as The Oklahoma Administrative Code, or, prior to its publication, the compilation of codified rules authorized by 75 O.S. § 256(A) (1) (a) and maintained in the Office of Administrative Rules. "OSDH" means Oklahoma State Department of Health. "Personal care" means assistance with meals, dressing, movement, bathing, or other personal needs, or general supervision of the physical and mental well-being of a person who is currently unable to maintain a private, independent residence, or who has limited abilities in the managing of his or her person, whether or not a guardian has been appointed for such person. "Recovery" means a journey of healing and transformation enabling a person with a mental health and/or substance abuse diagnosis to live a meaningful life in the community of his or her choice while striving to achieve his or her full potential. The process of recovery leads individuals toward the highest level of autonomy of which they are capable. Key characteristics of recovery include: (A) Recovery is self directed, personal and individualized (not defined by treatment providers or agencies); (B) Recovery is holistic. Recovery is a process through which one gradually achieves greater balance of mind, body and spirit in relation to other aspects of one's life that can include family, work and community; (C) Recovery moves beyond symptom reduction and relief (i.e. meaningful connections in the community, overcoming specific skill deficits, establishing a sense of quality and well-being); (D) Recovery is both a process of healing (regaining) and a process of discovery (moving beyond); (E) Recovery encompasses the possibility for individuals to test, make mistakes and try again; and (F) Recovery can occur within or outside the context of professionally directed treatment. "Registered/licensed dietitian" means a person who is registered as a dietitian by the American Dietetic Association and licensed by the Oklahoma Board of Medical Licensure and Supervision. "Resident" means a person residing in a residential care facility certified by ODMHSAS. "Residential care facility" or "RCF" means any house, home, establishment or institution licensed pursuant to the provisions of the Oklahoma Residential Care Home Act 63 O.S., §§ 1-819 through 1-840, other than a hotel, fraternity or sorority house, or college or university dormitory, is certified pursuant to 43 O.S. § 3-315 as a Community Residential Mental Health Facility and offers or provides residential accommodations, food service and supportive assistance to its residents or houses any resident requiring supportive assistance that are ambulatory, essentially capable of managing their own affairs and not routinely requiring nursing care or intermediate care. "Restraint" refers to manual, mechanical, and chemical methods that are intended to restrict the movement or normal functioning of a portion of the individual's body. "Seclusion" means the placement of an individual or individuals alone in a room or other area from which egress is prevented by a physical barrier. "Socialization activities" means all activities which encourage interaction and the development of communication, interpersonal, social and recreational skills, and can include client education. "Special need (persons with)" means any persons with a condition which is considered a disability or impairment under the "American with Disabilities Act of 1990" including, but not limited to the deaf or hard of hearing, visually impaired, physically disabled, developmentally disabled, persons with disabling illness, persons with mental illness. See "Americans with Disabilities Handbook," published by U.S. Equal Employment Opportunity Commission and U.S. Department of Justice. "Supportive assistance" means the service rendered to any person which is sufficient to enable the person to meet an adequate level of daily living. Supportive assistance includes but is not limited to housekeeping, assistance in the preparation of meals, assistance in the safe storage, distribution and administration of medications, and assistance in personal care as is necessary for the health and comfort of such person. The term "supportive assistance" shall not be interpreted or applied so as to prohibit the participation of residents in housekeeping or meal preparation tasks as a part of the written treatment plan for the training, habilitation or rehabilitation of the resident prepared with the participation of the resident, the mental health or drug or alcohol services case manager assigned to the resident and the administrator of facility, or his or her designee. Supportive assistance shall not include medical service. The attention of the facility is drawn to the distinction between the use of the words "shall," "should," and "may" in this chapter: (1) "Shall" is the term used to indicate a mandatory statement, the only acceptable method under the present standards. (2) "Should" is the term used to reflect the most preferable procedure, yet allowing for the use of effective alternatives. (3) "May" is the term used to reflect an acceptable method that is recognized but not necessarily preferred. These Standards and Criteria are applicable to all RCFs under contract with ODMHSAS as set forth in 43A O.S. § 3-315. (a) The RCF shall have negotiated formal written agreements with other behavioral health service providers to assure availability of continuous community based services to residents who will potentially need those services. The agreements must define responsibilities of each service entity. The Agreement(s) shall be renewed on an annual basis. If the Agreement is not obtained, the RCF shall show documentation of efforts to obtain the Agreement(s). At a minimum, there shall be agreements in place to sufficiently meet the emergency mental health needs of clients as well as insure continuous access to and collaboration with an array of outpatient behavioral psychiatric and rehabilitation services, including appropriate access to integrated services for individuals with co-occurring substance disorders. (b) To ensure continuity of care with all components of services, these Agreements shall address the roles and responsibilities of the RCF, the local providers of community-based behavioral health services and any other pertinent party. One of the roles and responsibilities addressed shall be to provide access to crisis stabilization and inpatient services. (c) Compliance with 450:16-5-1 shall be determined by a review of documentation, including agreement(s) signed by all necessary parties; or agreement(s) signed by some of the parties with further notes from the RCF stating the date of attempts to have the agreement(s) signed by the other providers. (a) Onsite socialization and recreation activities shall be provided by the RCF to residents a minimum of three (3) times per week, and shall occur on separate days. These activities shall total a minimum of three (3) hours of activity per week, and shall be provided in addition to exercise and daily living skills. (b) Additional activities shall be provided by the RCF, away from the facility, two (2) or more times per week for those who do not attend Clubhouse or general psychiatric rehabilitation programs or for those who choose to attend the activities away from the facility. (c) To insure variety, a minimum of three (3) of the activities offered per week, exclusive of ADL and exercise, shall be different activities. (d) Residents shall be involved in the planning of activities. (e) A monthly calendar of scheduled recreational and social activities shall be developed and posted in each building occupied by residents throughout the RCF. (f) Calendars of actual recreational and social activities shall be filed at the end of each month and maintained for at least six (6) months following the expiration of the period of certification. (g) Documentation of the scheduled social and recreation activities shall be made and kept as follows: (1) There shall be a record of whether, or not, each of the scheduled activities for each month were held. (2) There shall be a record of the residents' participation in each of the month's scheduled activities. (3) The records in (1) and (2) shall be retained for at least six (6) months following the expiration of the period of certification. (h) Compliance with 450:16-5-2 shall be determined by on-site observation; resident, staff, and CMHC staff interviews; and RCF documentation such as calendar of events, facility attendance sheets, residents' council minutes or compliance with 450:16-29-8, if an Enhanced Residential Care facility. (a) The RCF shall provide instruction and assistance in utilization of community resources and activities, such as post office, veteran services, Indian Health services, health fair, county fair, church, and independent housing services. (b) Residents should receive instruction and assistance in utilization of primary health resources, and in substance disorder recovery resources such as twelve-step or similar support resources as is appropriate and desired by the resident. (c) The RCF shall offer residents assistance with money management, including budgeting for independent housing, working with landlords, and understanding lease agreements. This assistance shall be offered through individual or group instruction or classes. (d) Residents shall be individually assisted and instructed regarding activities of daily living, including but not limited to personal hygiene and grooming, a minimum of five (5) days per week. (e) The RCF shall provide or arrange for instruction to residents on at least a quarterly basis regarding early warning signs of diseases to better educate residents in the identification of possible health problems. Training dates, topic, attendees, and the speaker(s) or trainer(s) shall be documented. (f) The RCF shall provide or arrange for instruction to residents on at least a quarterly basis regarding psychiatric illnesses and medication, as well as use of and dependence on substances (including nicotine and caffeine) to enable the resident to understand his or her illness and to help residents make better decisions about substance use and psychiatric treatment management in order to help them achieve recovery goals. Training dates, topic, attendees, and the speaker(s) or trainer(s) shall be documented. (g) Compliance with 450:16-5-4 shall be determined by on-site observation; resident, staff, and CMHC staff interviews; RCF documentation such as calendar of events, residents' council minutes, and other in house documentation. (a) The RCF shall offer residents physical exercise a minimum of twenty (20) minutes, three (3) days per week. (b) Compliance with 450:16-5-5 shall be determined by on-site observation; resident, staff, and CMHC staff interviews; and RCF documentation such as calendar of events. (a) In order to protect the resident's rights, and insure involvement of the resident's case manager, the RCF shall be required to contact, consult with and obtain the approval of the resident, prior to terminating services to the resident. Consultation with the resident's family or significant other, when involved with the resident's care, and the local and receiving CMHC or other treatment provider prior to moving or relocating any resident who is a mental health client with ODMHSAS shall be documented. No movement or relocation of any mental health client shall be conducted without such prior consultation and approval. If any relevant parties shall disagree with the movement, there shall be substantial reason(s) documented in the RCF's records. (b) In the event of the death of a resident, a summary statement shall be placed in the individual resident's file, and notification made to the ODMHSAS Office of Consumer Advocacy in accordance with 450:16-7-1. (c) Compliance with 450:16-5-6 shall be determined by a review of Office of Consumer Advocacy records; resident files; other RCF documentation as relevant and applicable; or resident, family, or significant other interviews. (a) RCFs shall be licensed by the Oklahoma State Department of Health in accordance with 63 O.S. §§1-820 through 1-840 and OAC 310:680-3-1. (b) RCFs shall comply with all applicable state and federal regulations, including but not limited to OAC 310:680. (c) RCFs shall provide evidence of such licensure and compliance to the Department. (a) The RCF shall assure residents have clothing and shoes appropriate to the season. (b) Clothing, including shoes, worn by residents shall be clean, in good repair, and be of appropriate size. (c) Residents shall have personal possession of their own clothing unless contraindicated according to RCF documentation, corroborated by CMHC staff. (d) The RCF shall have a mechanism for provision of clothing for residents who do not have sufficient or appropriate clothing of their own. (e) Compliance with 450:16-13-7 shall be determined by on-site observation; and resident, staff, and CMHC staff interviews. (a) The RCF shall provide residents with grooming and hygiene supplies, including hair care supplies, as needed. The grooming and hygiene supplies shall take ethnicity and allergies into consideration. (b) Compliance with 450:16-13-12 shall be determined by on-site observation; and resident, staff, and CMHC staff interviews. (a) Bathroom tubs , showers and sinks shall be clean and in good repair. (b) Compliance with 450:16-13.1 shall be determined by on-site observation; and, if applicable, a review of OSDH on-site inspection reports. (a) Toilets shall be clean and in good repair, and provide individual privacy for residents. (b) Compliance with 450:16-13.1 shall be determined by on-site observation; and, if applicable, a review of OSDH on-site inspection reports. (a) Toilet tissue shall be easily accessible to all residents. (b) Compliance with 450:16-13-31 shall be determined by on-site observation; and a review of OSDH reports. (a) The RCF shall make available indoor recreational equipment such as, but not limited to, crafts, checkers, and other board games, to the residents. (b) The RCF shall make available outdoor recreational equipment such as, but not limited to, horseshoes, badminton, and volleyball, to the residents. (c) Compliance with 450:16-13-36 shall be determined by on-site observation. (a) The RCF shall assist the residents in accessing needed psychiatric care. (b) Compliance with 450:16-13-42 shall be determined by resident, staff, and appropriate CMHC staff interviews; and a review of in-house documentation. (a) The RCF shall assist the residents in utilizing local resources such as local dentists or donated dental services. (b) Compliance with 450:16-13-43 shall be determined by resident, staff, and appropriate CMHC staff interviews; and a review of in-house documentation. (a) The RCF staff shall consult with the treating physician(s) of residents to better understand the illness(es) of each resident, to assure that he/she is receiving appropriate care within the RCF. (b) Compliance with 450:16-13-44 shall be determined by resident, staff, and appropriate CMHC staff interviews; a review of in-house documentation; and Annual Health Assessments. (a) The RCF shall comply with all OSDH medication regulations and have a current OSDH report free of medication related deficiencies. (b) RCF staff persons who have successfully completed medication administration technician training, or appropriately licensed personnel, shall administer medications. (c) Compliance with 450:16-13-48 shall be determined by a review of OSDH inspection reports; a review of the RCF's medication administration documentation and personnel records; and staff and resident interviews. Each facility certified by or under contract with ODMHSAS shall comply with the applicable rules in Title 450, Chapter 15. Consumer Rights, including but not limited to rules for resident grievance policy. (a) The RCF shall provide new direct care staff with an orientation within thirty (30) days of hire which, at least, consists of instructions on: (1) Orientation of RCF policies and procedures to include residents' rights, confidentiality, and abuse policy. (2) Orientation of ODMHSAS standards and criteria for RCF. (3) Techniques and philosophies which addresses appropriate non-violent intervention and potentially aggressive interpersonal conflicts, staff attitudes which promote dignity and enhanced self-esteem, keys to effective communication skills, verbal and non-verbal interaction and non-violent intervention. This training must be one-hour in length, at a minimum. (4) Orientation to the RCF policy and services for helping clients with substance use issues, and techniques for facilitating conversations with clients about substance use, as well as assisting them with making better choices and developing skills to implement those choices. (b) Compliance with 450:16-21-1 shall be determined by a review of staff personnel files; and orientation procedures and materials. (a) RCF residents are dependent on staff for their physical health, safety and mental well-being. Therefore, a direct care staff member shall be on duty, awake and accessible, at all times when residents are present. The on-duty person shall meet the definition of Direct Care Staff as stated in the Definitions section (450:16-1-2). (b) Compliance with 450:16-21-3 shall be determined by a review of employees' schedules; resident interviews; and personnel files. (a) The administrator of the RCF shall maintain current licensure as a Residential Care (RC) Administrator, Residential Care (RC) / Assisted Living (AL) Administrator, or Long-Term Care Administrator through the Oklahoma State Department of Health (OSDH). (b) The administrator of the RCF shall complete eight (8) hours of training on mental health and substance use disorder-related subjects within thirty (30) days of the administrator’s hire date and each calendar year thereafter . These eight (8) hours of training can be included in the hours of training required to maintain licensure through OSDH, and must include at least one (1) hour of training regarding substance use disorders and intervention strategies and at least one (1) hour of non-physical intervention training. The non-physical intervention training must address techniques and philosophies for appropriate non-violent interventions for potentially physical interpersonal conflicts, including verbal and non-verbal interactions. This non-physical intervention training curriculum must either be pre-approved by ODMHSAS or documented in a manner prescribed by ODMHSAS that demonstrates compliance with these requirements. (c) The administrator of the RCF shall maintain current certification in Cardiopulmonary Resuscitation (CPR) and basic first aid. (d) Compliance with 450:16-21-4 shall be determined by a review of the administrator's personnel file. (a) All RCF direct care staff shall annually receive, and have documented the dates attended and subject matter taught, for the following: (1) Review of RCF policies and procedures to include residents' rights, confidentiality, and abuse policy. (2) Review of ODMHSAS standards and criteria for RCFs; (3) Techniques and philosophies addressing appropriate non-violent intervention and potentially aggressive interpersonal conflicts, staff attitudes which promote dignity and enhanced self-esteem, keys to effective communication skills, verbal and non-verbal interaction and non-violent intervention. This training must be one-hour in length, at a minimum. (b) All direct care staff of the RCF shall annually receive twelve (12) hours of in-service or other training. (c) Compliance with 450:16-21-5 shall be determined by a review of the staff training or personnel files. (a) The RCF shall provide or arrange transportation for residents for essential community based services as defined in the residents outpatient behavioral health treatment plan, including but not limited to behavioral health rehabilitation services, medical clinic, lab, intake and assessment, and crisis intervention services and transportation for other required local routine medical examinations and care. Such transportation shall be at no cost to the residents. (b) All staff persons who drive RCF vehicles in the transportation of the residents shall have a valid and appropriate Oklahoma driver's license (i.e., a bus driver must have a commercial chauffeur's license). (c) RCF staff who transport residents shall be currently certified in first aid and cardiopulmonary resuscitation (CPR). (d) Compliance with 450:16-23-1 shall be determined by a review of RCF documentation; staff interviews; client interviews; and appropriate CMHC staff interviews. (a) The RCF shall be responsible for assisting all residents in obtaining needed professional or generic services; and, if needed, providing transportation, at no cost to resident, for same. Generic services are those of barbers, hairdressers, etc. or any services required by anyone of the community population for which residents have a general need. (b) The RCF is not required to bear the cost of these professional or generic services. (c) Compliance with 450:16-25-1 shall be determined by a review of RCF documentation; resident interviews; staff interviews; and interviews with appropriate CMHC staff. (a) The RCF shall have a policy stating awareness of and intent to comply with state and federal regulations regarding persons with special needs. (b) Compliance with 450:16-25-2 shall be determined by a review of RCF written policy and procedures; and any other supporting documentation. (a) Annually, the RCF shall monitor and document each resident's physical conditions to detect early indications of health or nutritional risks. (b) This assessment shall be completed by a Registered Nurse, Nurse Practitioner, Physician's Assistant, Doctor of Medicine, or Doctor of Osteopathy licensed in the State of Oklahoma, and said person shall complete the assessment based on personal examination/observation of the resident in addition to the resident's records. (c) Assessments for new residents shall be completed within ninety (90) days of admission to the RCF. If an assessment has been completed at another facility within the preceding twelve (12) months before admission to the current RCF, a copy of that assessment will suffice, with annual assessments thereafter completed on the basis of the previous assessment. (d) Compliance with 450:16-25-3 shall be determined by a review of RCF documentation. (a) The RCF shall have written policies and procedures regarding resident behavior, strictly prohibiting certain actions which shall include, but are not limited to: (1) Corporal punishment; (2) Abuse; (3) Verbal abuse; (4) Seclusion or chemical, mechanical or physical restraint of residents; or (5) Any other action that is, or could be, potentially harmful to the resident. (b) RCF policy should clearly state that at no time may an RCF resident supervise or discipline another RCF resident. (c) RCF staff shall not deny a resident a nutritionally adequate daily diet, e.g., a resident who is habitually late for meals shall not be denied food as a means of encouraging promptness. (d) Compliance with 450:16-27-5 shall be determined by a review of RCF documentation (policies and procedures, rules, other); resident interviews; staff interviews; and appropriate CMHC staff interviews. (a) The Enhanced RCF shall have no less than two (2) staff persons awake and accessible by residents on duty each shift. (b) Compliance with 450:16-29-2 shall be determined by observation during the site visit; and a review of the Enhanced RCF documentation, e.g., staffing schedule; and resident, staff and CMHC staff interviews. (a) The Enhanced RCF shall employ at least one full-time licensed registered nurse. (b) Compliance with 450:16-29-2.1 shall be determined by a review of the RCF's documentation. (a) The Enhanced RCF shall have signed written consultation agreements with: (1) A registered/licensed dietitian; and (2) A licensed physician. (b) These consultation agreements shall be on file and accessible to the ODMHSAS reviewers at the time of on-site visit. If there is reason to believe that one or both of the agreements are, or may be, not in effect, the reviewers shall contact the listed consultant(s) to verify the status of their agreement. (c) The Enhanced RCF shall update these consultant agreements annually. (d) Compliance with 450:16-29-3 shall be determined by a review of RCF consultation agreements. (a) Individuals to be served by an Enhanced RCF shall be referred only by a ODMHSAS hospital or a community mental health center (b) Compliance with 450:16-29-4 shall be determined by a review of Enhanced RCF documentation; and interviews with Enhanced RCF and CMHC staff. (a) Individuals to be served by the Enhanced RCF shall be adults who have a serious mental illness. (b) The Enhanced RCF shall have written admission criteria. (1) This written admission criteria shall be on file and accessible at the Enhanced RCF to ODMHSAS staff. (2) The criteria shall indicate the Enhanced RCF serves individuals who cannot be accommodated in a RCF, a lesser intensive residential service setting or based on the judgment of the individual's treatment team from the referring CMHC or the ODMHSAS inpatient unit that a RCF or other placement would not provide the structured environment needed by the consumer at this time. (c) Compliance with 450:16-29-7 shall be determined by a review of, the written admission criteria, resident interviews, client records showing prior failed placements, ODMHSAS client data cores, correspondence or minutes of meetings between the RCF and CMHC, and CMHC staff interviews. (a) Enhanced RCF activities shall include a minimum of three (3) on-site activities and two (2) activities away from the RCF per week. These activities shall be scheduled, structured and supervised group activities, and shall total at least twelve (12) hours of activity per week. (1) Group activities shall be accessible to all residents. (2) Activities shall be in addition to exercise and daily living skills training. (3) Activities shall be age appropriate. (4) Activities should be based on resident's individual and collective preferences. (b) Compliance with 450:16-29-8 shall be determined by a review of activities calendar, residents' files, and interviews with residents, staff and CMHC staff. (a) To encourage maintenance of, and foster continued improvement in, quality of resident care, compliance with Subchapters 5 (Services) and 13 (Quality of Life) shall be reviewed and assessed during an unannounced site visit prior to the annual recertification review visit. (b) A written report of the results of this review may be provided to the facility, the ODMHSAS Board, or other authorities as appropriate.